Diverticulum Research Articles

Synchronous association of two neuroendocrine gastroenteropancreatic tumors, an adenocarcinoma of the cecum, and a Meckel's diverticulum: a case report.

Neuroendocrine gastroenteropancreatic tumors constitute a heterogeneous group of neoplasms, with the primary tumors being located in the gastric mucosa, pancreas, and small and large intestine. The development of a second primary malignancy in patients with these tumors is a well-described phenomenon, and the reported incidence ranges from 12% to 46%. The most common site of associated noncarcinoid malignancies is the gastrointestinal tract, which involves from 30% to 60% of the tumors. We report a case of concurrent colon carcinoma and two neuroendocrine tumors of the duodenum.

Safety and efficacy of transurethral diverticulum section for treatment of adult female urethral diverticulum

Objective To discuss the feasibility and the curative effect of transurethral diverticulum section in the treatment of female urethral diverticulum. Method We retrospectively analyzed the transurethral diverticulum section surgeries of 11 adult female patients diagnosed as urethral diverticulum in our hospital from August 2012 to October 2016.The patients aged from 33 years old to 74 years old with an average age of 43.Their medical histories varied from 1 month to more than 40 years with an average histories of 80 months. Major symptoms included odynuria, frequent micturition, dyspareunia, perineum bearing-down feeling, repetitive urinary tract infection, dysuria, urinary stuttering, penis masses, etc.One patient underwent TVT-O.Two patients had urinary catheterization before the disease.During physical examination, cystic masses of different sizes could be touched on anterior vaginal walls with pain and secretion.Cystic lesions can be found by imaging examination.Transurethral diverticulum section was performed under general anesthesia.Using needle electrode by resectoscope, we made an annular incision in the direction of the vertical axis of the urethra, from the beginning of diverticulum ostium. The diverticulum completely communicated with the urethra. In 11 patients of transurethral endoscopic, the urethral sphincter and the diverticulum wall appeared morphological integrity and no damage. There was no liquid drained to de vagina. There was no urethral sphincter injury and no urethral vaginal leakage. We observed the operation time, bleeding volume, diverticulum position, the number of diverticulum, urethral sphincter intraoperative. We also observed the postoperative symptoms, short-term and long-term complications. Result All surgeries went on well, in which urethral diverticula were fully opened. The operation time was 30-45 minutes, average 35 minutes. The amount of bleeding within 5 ml. 4 cases with multiple diverticulum, with 2 cases of diverticulum ostia were 2, 2 cases of diverticulum ostia were 3.The other 7 cases with single diverticulum, diverticulum ostium was 1.The catheters were removed 2 weeks after the surgery, after that all patients can urinate normally. The follow-up time was 5-55 months(mean, 24 months). All pre-surgical symptoms disappeared and no complication occurred, such as urethral stricture, urinary incontinence, urethro-vaginal fistula, etc. Conclusion Transurethral diverticulum section is a reliable treatment for female urethral diverticulum with positive curative effect and no obvious complication. Key words: Female; Urethral diverticulum; Transurethral

Super mini-percutaneous nephrolithotomy by ultrasound-guided for upper urinary tract stones

Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided for upper urinary tract stones. Methods The SMP procedure was done using a 7F mini-nephroscope with 3.3 F working channel and a 12 or 14 F nephrostomy sheath that possessed suction-evacuation function.The sheath was connected a specimen container then onto a negative pressure aspirator.Lithotripsy was performed using holmium: YAG laser and/or pneumatic lithotripter.From May 2015 to June 2016, 80 patients with upper tract stones underwent the SMP by ultrasound guidance. The ages of patients were 11 months 81 years.The stone ranged in size from 0.8~3.5 cm , mean(1.7±0.6)cm.Among the 80 patients, single pelvis stones in 28 cases, pelvic-low pole in 26 cases and upper ureter stones in 16 cases, pelvic-upper ureter in 3 cases, renal calculi with diverticulum in 5 cases and double renal pelvis and double ureter in 2 cases were found. Results All patients had a single stage of calculi, single channel in 79 cases, and double channel in one case. Thirty-three cases with F12 channel, 47 cases with F14 channel were found. Mean operative time was 6~70 min, mean(28.5±15.4)min .The stone free rate after 1 day was 95%(4/80). The stone-free rate at 1 month was 97.5%. The hemoglobin drop was 0~35 g/L, mean(12.8±9.5)g/L. Fever occurred in 2 cases.No one needed blood transfusion. None of the patients had nephrostomy tube and 76 patients had neither Double-J stent nor Foley catheter placed.The average hospital stay was 1~4 days, mean (2.20±0.75) days. Conclusions SMP with a suction-evacuation system is a safe and efficacious procedure for upper urinary tract stones smaller than 2.5 cm.It may be particularly suitable for children, patients with lower pole stones, and residual stones after previous surgical interventions. Key words: Urinary Calculi; Nephrostomy, Percutaneous

Large bladder diverticula: a comparison between laparoscopic excision and endoscopic fulguration

Objective: The treatment of bladder diverticula consists of diverticulectomy, mainly by a laparoscopic approach or transurethral resection of the diverticular neck and fulguration of the mucosa. The endoscopic approach is generally dedicated to small diverticula. The aim of this study was to compare laparoscopic diverticulectomy versus endoscopic fulguration for bladder diverticula larger than 4 cm.Materials and methods: A retrospective review of the medical records of consecutive patients undergoing endoscopic or laparoscopic treatment for bladder diverticula larger than 4 cm at two tertiary hospitals was performed. Therapeutic success was defined as either complete resolution or a decrease of at least 80% in the size of the diverticulum. Complications were recorded and graded according to the Clavien–Dindo classification.Results: All patients were treated with transurethral resection of the prostate in the same operative session. The endoscopic group included a cohort of 20 male patients. The median age, diverticular diameter and operative time were 65 years, 7 cm and 62.5 min, respectively. No early postoperative complications were observed. Therapeutic success was achieved in 15 cases (75%). The laparoscopic group included a cohort of 13 male patients with a median age of 63 years and median diverticular diameter of 7.0 cm. The median operative time was 185 min (p < 0.0001). Two grade III postoperative complications were observed (15.3%). Therapeutic success was achieved in all patients (100%).Conclusions: Acquired bladder diverticula larger than 4 cm can be effectively managed either by a laparoscopic approach or by endoscopic fulguration.

Pneumoperitoneum in a Micro – Preemie due to Perforated Meckel’s Diverticulum

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The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery.

ABSTRACTIntroduction:The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood.Objectives:To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery.Subjects and Methods:We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis.Results:There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012).Conclusions:The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

A rare case of small cell carcinoma of urinary bladder in a bladder diverticulum: Case report and review of literature

Small cell carcinoma of the urinary bladder (SCCB) is a rare and aggressive non-urothelial tumour of the urinary bladder. It represents neuro endocrine type of malignancy, being diagnosed on histopathology and immuno histo chemistry. Bladder diverticulum tumours are rare and present with early lamina propria invasion. Furthermore, the risk of bladder perforation is high during resection due to the lack of muscle. Thus, these tumours have a risk of being under-staged and have a poor prognosis. Till now, very few cases have been reported of SCCB in bladder diverticulum. Multi-modality management in the form of combined chemotherapy and surgery is required for the optimal management. We report this rare case and review the literature for the management of SCCB in bladder diverticulum.

Epidemiology and risk factors for diverticular disease.

Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. The prevalence of the disease is higher in elderly patients over 65 years old, recent studies show an increment also in youngers over 40 years old. Even its large prevalence in the population, its pathophysiology still remain poorly understood. It’s widely accepted that diverticula are likely to be the result of complex interactions among genetic factors, alteration of colonic motility, lifestyle conditions such as smoking, obesity, alcohol consumption, fiber and meat intake with diet. Recently many authors considered also alterations in colonic microbiota composition, co-morbidity with diabetes and hypertension and the chronic assumption of certain medications like PPI, ARB and aspirin, as important risk factors for the development of diverticulosis. The aim of this narrative review is to summarise current knowledges on this topic. (www.actabiomedica.it)

Autosomal recessive cutis laxa type-1 with complex systemic manifestations

Cutis laxa (CL) is a rare connective tissue disorder characterized by loose, sagging, and redundant skin. Both inherited and acquired forms are known. A 7-year-old boy, presented with loose, sagging skin chiefly over the face, extremities, and skin folds since birth with recurrent respiratory and systemic complaints. The patient had a characteristic senile bloodhound appearance. Chest X-ray findings included emphysema, bronchopneumonia, and pulmonary hypertension. Ultrasonographic examination showed cystitis and bladder diverticula. Two-dimensional echocardiography showed primary pulmonary hypertension. Histopathological examination with Verhoeff-Van-Gieson stain showed markedly reduced elastic fibers. Serum amino acids, copper, and ceruloplasmin were normal. About sixty cases of autosomal recessive cutis laxa type 1 (ARCL-1) have been reported in literature. There is no definitive treatment available at present, and symptomatic management is the mainstay of treatment. Differential diagnosis includes Ehlers–Danlos syndrome, congenital disorders of glycosylation syndrome, and pseudoxanthoma elasticum. We report this case of ARCL-1 for its rarity and complex systemic involvement.

A Case of Congenital Bladder Diverticulum in Children With Removal of the Mucous Membrane and Suturing of the Muscular Layer of the CBD

A Case of Congenital Bladder Diverticulum in Children With Removal of the Mucous Membrane and Suturing of the Muscular Layer of the CBD

A Case of Portal Venous and Systemic Gas Emerging in a Short Time Accompanied by Bladder Diverticulum Perforation

A Case of Portal Venous and Systemic Gas Emerging in a Short Time Accompanied by Bladder Diverticulum Perforation

Why are Diverticula of the Rectum Uncommon? Angiomorphological Hypothesis

Why are Diverticula of the Rectum Uncommon? Angiomorphological Hypothesis

Congenital left ventricular aneurysms and diverticula: an entity in search of an identity.

Congenital left ventricular aneurysm or diverticulum are rare cardiac malformations described in 809 cases since the first description in 1816, being associated with other cardiac, vascular or thoraco-abdominal abnormalities in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. In an experimental study, targeted knockdown of cardiac troponin T in the chick was performed at day 3, after the heart tube has formed. Morpholino treatment of gene TNNT2 at this stage led to the development of left ventricular diverticula (LVD) in the primitive left ventricular wall. Diagnosis of left ventricular aneurysms (LVA)/LVD can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most of LVA and LVD are asymptomatic or may cause systemic embolization, congestive heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies (echocardiography, magnetic resonance imaging or left ventricular angiography) visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications, options include surgical resection (especially in symptomatic patients), anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable cardioverter defibrillator (ICD) in case of symptomatic ventricular tachycardias, and occasionally combined with class I- or III-antiarrhythmic drugs. Cardiac death occurs usually in childhood, is significantly more frequent in LVA patients and caused by congestive heart failure in most of the cases, whereas patients diagnosed with LVD died more frequently from rupture of the LVD.

A meta-analysis of percutaneous nephrolithotomy versus other commonmethods: flexible ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of caliceal diverticulum calculi

Objective To compare the percutaneous nephrolithtomy (PCNL) and other two common methods: flexible ureteroscopic lithotripsy (FURL) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of caliceal diverticulum calculi, and to assess the efficacy and safety and provide the reference for the clinical treatment. Methods We searched CNKI, WanFang, VIP, Pubmed, SpringerLink to collect home and abroad literatures that have been published about the treatment of caliceal diverticular calculi.The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. Stone-free rates , symptom-free rates , complication rates, hospital stay, stone burden were observed. Results Seven papers involving 284 patients were finally obtained after screening, including 2 articles in Chinese, 5 articles in English. Meta-analysis showed that the PCNL was far better than the others (FURL and ESWL ) in the efficacy of the total stones-free rate (OR 9.39, 95%CI: 2.98~29.61, P<0.001). Symptom-free rates was better than the others (OR 4.09, 95%CI: 1.14~4.66, P=0.03). It was no statistically significant difference in complication rate between two groups (OR 1.40, 95%CI: 0.60~3.29, P=0.44). In addition, the PCNL and FURL in the stones-free rate were compared, the result of Meta-analysis indicated that the stone-free rate in PCNL group was significantly higher than that in FURL group (OR 3.43, 95%CI: 1.42~8.31, P=0.006). Conclusions PCNL is safe and effective for the treatment of caliceal diverticulum calculi. It is better than the others (FURL and ESWL ) in the efficacy of the total stones-free rate and symptom-free rates and it is not statistically significant difference in complication rate between two groups.So PCNL can be used as the preferred method of treatment of caliceal diverticulum calculi. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Meta-Analysis

Imaging findings of female Skene gland disease

Objective To investigate the imaging characteristics of female Skene-gland (periurethral glands) disease. Methods A retrospective analysis of preoperative imaging findings was performed in 15 female patients with surgical-pathological proven Skene gland disease. MRI scans were performed in 8 cases, CT scans were performed in 5 cases, both CT and MRI were performed in 2 cases. Imaging characteristics were observed and summarized. Results There were 3 types of diseases, including: (1) Skene gland cyst (n=3), located in the distal and posterolateral urethra or close to the proximity of urethra, presenting as cystic lesions with teardrop shape on sagittal images, which appeared as hypo-attenuation on non-enhanced CT, and hypo-intensity on T1WI, hyper-intensity on T2WI, and without enhancement. One case complicated with infection presented as hyper-intensity on T1WI and gaseous intensity inside, with thickened cystic wall and enhancement. (2) Urethral diverticulum communicating with Skene gland (n=10), located in the middle or distal and posterolateral urethra, presented as a horseshoe shaped cystic lesion partially surrounding the urethral (n=3) or spoke wheel-like cystic lesion with multiple septum completely surrounding the urethra (n=7). They appeared as fluid attenuation on unenhanced CT, and hypo-intensity on T1WI, hyper-intensity on T2WI and without enhancement. Heterogenous signal or attenuation and enhanced septum or cystic wall were found in 6 cases complicated with infection. (3) Malignant tumor (n=2, one adenocarcinoma and one neuroendocrine carcinoma), presented as cystic-solid mass surrounding the urethral, showing heterogenous low attenuation on nonenhanced CT and iso-to hyper-intensity on T2WI and hypo-to iso-intensity on T1WI with significant enhancement. Conclusions Female Skene-gland disease has specific occurrence location and imaging characteristics. Key words: Cysts; Diverticulum; Adenocarcinoma; Tomography, X-ray computed; Magnetic resonance imaging; Periurethral gland

Holmium laser enucleation of the prostate is an effective treatment in patients with concomitant bladder diverticula and outlet obstruction.

Bladder diverticula can be congenital or secondary to benign prostatic hyperplasia with bladder outlet obstruction, and be a source of high postvoid residuals prompting surgical intervention. We sought to evaluate the outcomes of patients with bladder diverticula undergoing holmium laser enucleation of the prostate (HoLEP) for bladder outlet obstruction. We retrospectively reviewed HoLEP patients with at least one bladder diverticulum at two high volume institutions. All cases were performed in similar fashion. Preoperative, perioperative, and postoperative patient variables were obtained and assessed. Of 2746 HoLEP patients, 51 were diagnosed with bladder diverticula before surgery. Mean prostate size was 80.8±50.0g and mean diverticulum size (largest if multiple) was 5.5±2.6cm. Preoperatively, urinary retention requiring catheterization was present in 28 (55%) patients. In the remainder, mean preoperative AUASI was 19.7, peak flow 7.2ml/s, and post-void residual (PVR) 365ml. At most recent follow-up (mean 12.2months), mean total AUASI was 8.6, peak flow 27.1ml/s, and PVR 145ml with 71, 276, and 221% improvement, respectively. All patients were voiding and none required catheterization. Only three (6%) patients required diverticulectomy at a mean of 15.2months after HoLEP for the following indications: hematuria (one patient)and urinary retention(two patients). HoLEP is an effective method of outlet obstruction treatment in patients with bladder diverticula. Most patients, even with large diverticula, do not require further treatment after the outlet obstruction has been relieved and can avoid more invasive surgical interventions.

The individual therapy of urethrocutaneous fistula after primary urethroplasty for hypospadias

Objective To investigate the proper procedure for repairing different urethrocutaneous fistulas after primary urethroplasty for hypospadias. Method There were 101 cases, whose age ranged from 27 months to 171 months (mean 61 months), underwent urethrocutaneous fistula repairing secondary to the primary hypospadiasis urethroplasty from January 2010 to December 2015. The methods of the repairing were chosen mainly on the site and the size of the fistula, which included three types. The coronal fistula with a thin band of tissue stretching between the glans wings was classified as type I (n=24). For the rest of the small fistulas at penis coronal ditch and penis body, the small fistula (diameter <3 mm) was classified as type Ⅱ (n=57) and the large fistula (diameter ≥3 mm) was classified as type Ⅲ(n=30). The urethroplasty was performed in the type I cases. The ligation and transfixion was performed in type Ⅱ cases. And the tension free repairing with continuous suture was performed in type Ⅲ cases. De-epithelization dartos fascia flap or tunica vaginalis flap covering was performed in all cases. After removing the catheter, all cases were followed-up at least 1 year. The successive operation was termed as no complication, such as urethral stricture, urethral diverticulum and urethrocutaneous fistula. Result Totally 111 fistulas were repaired by the methods described above. The mean followed-up duration was 32 months (ranging 12-48 months). Total recurrence of fistula was 11.7%(13/111) in different type fistulas, including 16.7%(4/24) in type Ⅰ, 3.5%(2/57) in type Ⅱand 23.3%(7/30) in type Ⅲ. Conclusions Different classification and treatment of urethrocutaneous fistula after urethroplasty by the site and size of fistula can improve the outcome of the operation. It is necessary to cover the tissue tightly to a new urethra during the operation. Key words: Urethrocutaneous fistula; Hypospadias; Children

Diagnosis of congenital malformations of the right atrium by echocardiography

Objective To review the imaging characteristics and evaluate the diagnostic value of echocardiography for congenital malformations of the right atrium (CMRA). Methods Doppler echocardiography was performed and these images were compared with operative findings in 11 children with CMRA. Results CMRA was characterized by idiopathic dilation of the right atrium and right heart appendage, congenital diverticulum of the right atrium and coronary sinus. CMRA consisted of idiopathic dilation of the right atrium (4 cases), congenital diverticulum of the right atrium(3 cases), idiopathic dilation of the right heart appendage (2 cases), and congenital diverticulum of the coronary sinus (2 cases). The associated malformations included patent foramen ovale (6 cases), atrial septal defect (3 cases), pulmonary hypertension (3 cases), and hypoplastic tricuspid valve (2 cases). Eight of 11 cases were diagnosed correctly, and other 3 cases were misdiagnosed, in which 1 case with idiopathic dilation of the right atrium misdiagnosed as Ebstein′s anomaly, 1 case with congenital diverticulum of the right atrium misdiagnosed as congenital enlargement of the right atrial appendage, and 1 case with congenital diverticulum of the coronary sinus misdiagnosed as coronary sinus stenosis. Conclusions CMRA could be diagnosed accurately by Doppler echocardiography, but it is prone to be misdiagnosed and must be distinguished from Ebstein′s anomaly. Key words: Echocardiography, Doppler; Congenital malformations of the right atrium

Causes of flexible ureterorenoscopy with holmium laser lithotripsy failure in 46 patients with upper urinary tract calculus

Objective To analysis reasons of failure in the treatment of flexible ureterorenoscopy with holmium laser lithotripsy. Methods From October 2014 to March 2016, 472 patients with upper urinary tract calculus were treated by flexible ureterorenoscopy with holmium laser lithotripsy, 46 cases of surgery procedures failed were recorded and analyzed. Results The causes of failure included stricture or tortuous ureter, the infundibulopelvic angle was smaller than 30°, the diverticular neck was not found, with infection of pelvis, equipments damaged and ureteral injury. Conclusions Placed Double-J stent 1~2 weeks before operation, antibiotic therapy in patients with urinary tract infection, CT and IVU should performed in all patients, indwelling guide wire during operation, light and soft performance, percutaneous nephrolithotomy are needed. All these are key points in flexible ureterorenoscopy with holmium laser lithotripsy. Key words: Urinary Calculi; Ureteroscopes; Lasers, Solid-State; Lithotripsy, Laser

Band Ligation Shown as Most Effective Therapy for Colonic Diverticular Bleeding

The comparative effectiveness of different endoscopic therapies for colonic diverticular bleeding has been assessed in a meta-analysis. A total of 16